Infants with very low birth weights (under 1500 grams at birth) are a vulnerable patient population. The high rates of infant mortality in the United States are concentrated among these babies. While they account for only 1 percent of births, VLBW infants account for 46 percent of infant deaths. Infants with very low birth weights are also a high cost patient population. NICU care for infants with very low birth weights are among the most expensive hospitalizations. For instance, the average cost of the initial hospitalization for a surviving infant with a birth weight between 500 and 749 grams in 1987 was $157,000. Yet, the most recent data for the costs of care for these infants are a decade old. Most of the literature is based on data that is two decades old. There have been many changes in that time period that would be expected to change the cost and cost-effectiveness of care for these infants. This includes changes in the health care marketplace, such as the emergence of managed care plans and shifts in the sites of care, and technological changes in both neonatal and obstetric care. The latter have been largely responsible for a 40 percent reduction in infant mortality rates since 1980. Information on cost and cost-effectiveness of care is important for policy makers. For instance, the Oregon Medicaid program initially proposed placing care for infants with birth weights under 500 grams at the bottom of their cost-effectiveness rating, thus essentially denying care for these infants. Ultimately, care was not denied due to legal challenges based on the Americans with Disabilities Act. Information on costs of care for VLBW infants is particularly important for determining the cost-effectiveness of interventions aimed at decreasing the rate of preterm birth. The latter is a high policy priority in the United States. The US has one of the highest infant morality rates among industrialized nations, due largely to high rates of premature births. The prior literature has demonstrated that the cost-effectiveness of these interventions depends on how the birth weight distribution is shifted, particularly at the lowest birth weights. In this study we propose to fill this knowledge gap by using more recent data, from 1997-2000 to answer the following questions: (1) What are the costs of care for VLBW infants? (2) What is the cost-effectiveness of care for VLBW infants? (3) How do costs and cost-effectiveness of care vary with the degree of prematurity? The study will use data from 29 hospitals in the Vermont Oxford Network over the study period. It includes 13,610 infants with birth weights under 1500 grams, the largest sample of VLBW infants ever included in a cost study. The Vermont Oxford Network is a voluntary, collaborative network of neonatal intensive care units organized to improve the effectiveness and efficiency of medical care for newborn infants.